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All mechanical low rectal anastomosis in children
G Mattioli1, P Buffa, M Martinelli
1Department of Pediatric Surgery, University of Genoa School of Medicine, Giannina Gaslini Scientific Institute, Italy.
Insights
Mechanical staplers are safe and effective for low rectal anastomosis in children, reducing operative time and dehiscence risk. However, instrument size limits use in neonates and small infants.
Area of Science:
- Pediatric surgery
- Gastrointestinal surgery
Background:
- Low rectal anastomosis is a critical surgical procedure in pediatric patients.
- Traditional suturing techniques can be associated with complications such as anastomotic dehiscence.
Purpose of the Study:
- To evaluate the feasibility and utility of mechanical suturing for low rectal anastomosis in pediatric surgical patients.
- To assess the safety and efficacy of mechanical staplers in this population.
Main Methods:
- A cohort of 31 children underwent low rectal anastomosis between 1993 and 1996.
- Procedures included modified Duhamel for Hirschsprung's disease, intestinal neuronal dysplasia, and Knight-Griffen for ulcerative colitis.
- Mechanical staplers (circular and linear endoscopic) were used for various anastomotic configurations.
Main Results:
- Mechanical suturing, termed "viscero-synthesis," was successfully employed in all cases.
- Circular staplers facilitated end-to-end and end-to-side anastomoses.
- Linear endoscopic staplers (GIA) were used for rectocolic wall consolidation in the Duhamel procedure.
Conclusions:
- Mechanical staplers are safe and effective for low rectal anastomosis in children.
- This technique offers benefits such as reduced operative time and lower risk of anastomotic dehiscence.
- The size of available circular staplers restricts their application in neonates and very young infants.
Purpose:
The aim of this study is to demonstrate the feasibility and usefulness of mechanical suturing in children for low rectal anastomosis.
Methods:
The study group includes 31 children operated on from January 1993 to July 1996 by the same senior surgeon, performing the modified Duhamel procedure for Hirschsprung's disease in 17 children, intestinal neuronal dysplasia in seven, and the Knight-Griffen procedure in seven pediatric patients with chronic ulcerative colitis.
Results:
In all the cases the technique of "viscero-synthesis" was performed using the mechanical stapler. A circular stapler has been used for the end-to-end and the end-to-side anastomosis between the anal canal or the back wall of the rectum with the pulled viscus, while a linear endoscopic stapler (GIA) has been used for the consolidation of the rectocolic wall in the modified Duhamel technique.
Conclusions:
The results obtained demonstrate that the mechanical staplers in children are safe and effective in low rectal anastomosis, sparing operative time and reducing the risk of anastomotic dehiscence; however, the size of circular instruments limits its use in neonates and small infants.